Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs

2004 ◽  
Vol 35 (3) ◽  
pp. 341-351 ◽  
Author(s):  
R. SRINIVASA MURTHY ◽  
K. V. KISHORE KUMAR ◽  
D. CHISHOLM ◽  
T. THOMAS ◽  
K. SEKAR ◽  
...  
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Repeated Measures ◽  
Psychosocial Support ◽  
Community Outreach ◽  
Family Burden ◽  
Psychotic Symptoms ◽  
Community Based ◽  
Care Giving

Background. In resource-poor countries, there remains an alarming treatment gap for people with schizophrenia, particularly those living in rural areas. Decentralization of mental health services, including community-based outreach programmes, represents one obvious strategy for bringing appropriate care to these communities. This study set out to assess the costs and effects of such a programme in rural Karnataka in India.Method. Eight rural communities were visited by an outreach team, who identified cases of drug-naive or currently untreated schizophrenia. Recruited cases were provided with appropriate psychotropic medication and psychosocial support, and after obtaining informed consent were assessed every 3 months over one and a half years on symptomatology, disability, family burden, resource use and costs. A repeated-measures analysis was carried out to test for significant change in these outcome measures over this period.Results. A total of 100 cases of untreated schizophrenia were recruited, of whom 28% had never received antipsychotic medication and the remaining 72% had not been on medication for the past 6 months. Summary scores for psychotic symptoms, disability and family burden were all reduced significantly, with particular improvement observed at the first follow-up assessment. Increases in treatment and community outreach costs over the follow-up period were accompanied by reductions in the costs of informal-care sector visits and family care-giving time.Conclusions. Efforts to organize community-based care such as outreach services for people with schizophrenia living in more remote areas of resource-constrained countries can bring substantial benefits to patients and families alike.

scholarly journals Empowering traditional birth attendants as agents of maternal and neonatal immunization uptake in Nigeria: a repeated measures design

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chinedu Anthony Iwu ◽  
Kenechi Uwakwe ◽  
Uche Oluoha ◽  
Chukwuma Duru ◽  
Ernest Nwaigbo
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Repeated Measures ◽  
Average Length ◽  
Traditional Birth Attendants ◽  
Post Intervention ◽  
Repeated Measures Design ◽  
Birth Attendants ◽  
Culturally Adapted ◽  
Workshop Intervention

Abstract Background Adequate immunization coverage in rural communities remain a challenge in Nigeria. Traditional birth attendants (TBAs) form an integral part of the social, cultural and religious fabric in most rural communities in Nigeria. Despite their limitations in handling the complications of childbirth, TBAs are widely accepted and patronized, especially in rural areas. The objectives of the project were to empower TBAs and assess the use of a culturally adapted audio-visual workshop intervention to change their knowledge, attitude and willingness to promote immunization uptake. Methods A repeated-measures design that used a convenience sampling technique to select 90 TBAs from the three geopolitical zones of Imo State, Nigeria. The TBAs were engaged through a culturally adapted audio-visual workshop. Data were collected before and immediately after intervention using a pretested questionnaire. Chi square test was done to determine any significant association with the zone of practice and paired sample t-test analysis to determine any significant pre and post intervention change. Level of significance was set at p ≤ ·05. Results More than half of the TBAs had at most, a secondary level of education (54·4%). The average length of time they practiced as TBAs was 16 years with an average of ten birth deliveries per month. After the intervention, all the respondents (100%) reported a willingness to always promote immunization uptake and also, there was a statistically significant increase in Knowledge (p < ·000). Similarly, the level of knowledge in the post intervention period appeared to be significantly associated with the zone of practice (p = ·027). Conclusion The workshop intervention empowered the TBAs irrespective of their zones of residence by successfully improving their knowledge, though at varying levels; and consequently, their willingness to always promote immunization uptake.

scholarly journals Umbilical cord care through community-based distribution of chlorhexidine in rural Sindh, Pakistan

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Shah ◽  
Q Jamali ◽  
F Aisha
Keyword(s):  
Rural Communities ◽  
Data Collection ◽  
Umbilical Cord ◽  
Rural Areas ◽  
Health Workers ◽  
High Rate ◽  
Cord Care ◽  
Community Based ◽  
Sindh Province ◽  
At Home

Abstract Background Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality. Methods We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan. Results Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day. Conclusions Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan. Key messages Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.

scholarly journals Empowering Traditional Birth Attendants as Agents of Maternal and Neonatal Immunization Uptake in Nigeria: a repeated measures design.

2020 ◽  
Author(s):  
Chinedu Anthony IWU ◽  
Kenechi Uwakwe ◽  
Uchechukwu Raphael Oluoha ◽  
Chukwuma Duru ◽  
Ernest Nwaigbo
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Repeated Measures ◽  
Average Length ◽  
Traditional Birth Attendants ◽  
Post Intervention ◽  
Repeated Measures Design ◽  
Birth Attendants ◽  
Culturally Adapted ◽  
Workshop Intervention

Abstract Background: Adequate immunization coverage in rural communities remain a challenge in Nigeria. Traditional birth attendants (TBAs) form an integral part of the social, cultural and religious fabric in most rural communities in Nigeria. Despite their limitations in handling the complications of childbirth, TBAs are widely accepted and patronized, especially in rural areas. The objectives of the project were to empower TBAs and assess the use of a culturally adapted audio-visual workshop intervention to change their knowledge, attitude and willingness to promote immunization uptake. Methods: A repeated-measures design that used a convenience sampling technique to select 90 TBAs from the three geopolitical zones of Imo State, Nigeria. The TBAs were engaged through a culturally adapted audio-visual workshop. Data were collected before and immediately after intervention using a pretested questionnaire. Chi square test was done to determine any significant association with the zone of practice and paired sample t-test analysis to determine any significant pre and post intervention change. Level of significance was set at p ≤ ·05.Results: More than half of the TBAs had at most, a secondary level of education (54·4 %). The average length of time they practiced as TBAs was 16 years with an average of ten birth deliveries per month. After the intervention, all the respondents (100%) reported a willingness to always promote immunization uptake and also, there was a statistically significant increase in Knowledge (p<·000). Similarly, the level of knowledge in the post intervention period appeared to be significantly associated with the zone of practice (p= ·027). Conclusion: The workshop intervention empowered the TBAs irrespective of their zones of residence by successfully improving their knowledge, though at varying levels; and consequently, their willingness to always promote immunization uptake.

scholarly journals Testing a community-based distribution approach to reproductive health service delivery in Senegal (a study of community agents in Kébémer)

2004 ◽  
Keyword(s):  
Rural Communities ◽  
Reproductive Health ◽  
Service Delivery ◽  
Social Action ◽  
Rural Areas ◽  
Cost Effective ◽  
Health Service Delivery ◽  
Reproductive Health Services ◽  
Community Based ◽  
Integrated Cost

The Division of Reproductive Health (DSR) of the Senegal Ministry of Health and Social Action, in partnership with the Population Council’s FRONTIERS in Reproductive Health program and Management Sciences for Health (MSH), conducted a study to test and compare three ways of providing reproductive health services to rural communities in the Kébémer district of Senegal in terms of their effectiveness, cost, and cost-effectiveness. FRONTIERS and MSH collaborated with the DSR to design the interventions, MSH supported the DSR in implementing the interventions, and FRONTIERS undertook the evaluation. This study, funded by USAID, responded to the recommendations of a 1999 workshop, organized by FRONTIERS and the DSR, on the community-based distribution (CBD) approach, which defined alternative CBD models appropriate for Senegal. The DSR sees the development of community-based service delivery models as essential for the future of health care in Senegal. As noted in this report, the general objective of the study was to contribute to the development of an integrated cost-effective program to increase the accessibility and availability of reproductive health information and services in rural areas of Senegal.

Timely diagnosis of dementia in rural areas in Austria: the Dementia Service Centre model

2020 ◽  
pp. 103-126
Author(s):  
Stefanie Auer ◽  
Paulina Ratajczak ◽  
Edith Span ◽  
Margit Höfler
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Psychosocial Support ◽  
Controlled Trial ◽  
Support Providers ◽  
Upper Austria ◽  
Service Centre ◽  
Model Research ◽  
Diagnosis Of Dementia ◽  
Support Model

The Dementia Service Centre Model was developed in order to serve rural communities in Upper Austria. The goals of the Dementia Service Centre were defined as a multicomponent, low threshold, ‘one-stop shop’ psychosocial support model, specifically addressing the needs of persons with dementia and their family carers and support providers in rural communities. The main goals of the DSC care model are: a) timely detection of dementia, b) delaying the institutionalisation of persons with dementia and c) reducing the burden of support providers. In 2001, a data base was established with the goal to providing evidence for the support model. Research projects, including a randomized controlled trial, were conducted. The results of the research influenced the decision of policy makers to promote the model for roll-out. During the pilot phase, 7 Centres were opened. The model has been selected for rollout and in 2020 eleven Centres will be available.

scholarly journals Community-based aftercare following an emergency department presentation for attempted suicide or high risk for suicide: study protocol for a non-randomised controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Vida V. Bliokas ◽  
Alex R. Hains ◽  
Jonathan A. Allan ◽  
Luise Lago ◽  
Rebecca Sng
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Suicide Attempt ◽  
Repeated Measures ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Community Based ◽  
Treatment As Usual ◽  
The Impact

Abstract Background Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed ‘aftercare’ interventions). Methods A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. Discussion The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. Trial registration ACTRN12618001701213. Registered on 16 October 2018. Retrospectively registered.

scholarly journals Barriers to Meaningful Involvement in AIDS Service Organizations in Three Canadian Maritime Provinces

2015 ◽  
Vol 2 (2) ◽  
pp. 81
Author(s):  
Steven Michael Ross ◽  
Lynne Duffy ◽  
Leslie Jeffrey ◽  
Donna Bulman ◽  
Marni Amirault
Keyword(s):  
Rural Communities ◽  
Risk Behaviors ◽  
Rural Areas ◽  
Negative Influence ◽  
Small Sample ◽  
Service Organizations ◽  
Maritime Provinces ◽  
Community Based ◽  
Community Based Research ◽  
Meaningful Involvement

<p>A three-year, community-based descriptive study examined how meaningful involvement in AIDS Service Organizations (ASOs) is conceptualized and experienced in three Canadian Maritime provinces that are considered rural areas. This paper focuses on one aspect of the research, namely the barriers to meaningful involvement in ASOs. Thirty-five participants were interviewed who self-identified as current or past clients of an ASO and were living with, or engaging in, at-risk behaviors for HIV/AIDS. Photovoice, a qualitative Community-Based Research (CBR) strategy, was also used with a small sample because marginalized populations that are traditionally difficult to recruit for interviews have embraced this method due to its oral-based and interactive design. The contribution to the field of knowledge about barriers to meaningful involvement is organized around three main themes: (1) stigma, a major negative influence, is particularly powerful due to the nature of social structures in rural communities; (2) readiness for meaningful involvement, where poor health status or the desire to lead a normal life can significantly impact an individual’s involvement, and (3) characteristics of the ASO environment that are critical in determining the degree, if any, of meaningful involvement.<strong></strong></p>

scholarly journals Peripheral Inflammatory Biomarkers for Myocardial Infarction Risk: A Prospective Community-Based Study

2017 ◽  
Vol 63 (3) ◽  
pp. 663-672 ◽  
Author(s):  
Zhijun Wu ◽  
Zhe Huang ◽  
Wei Jin ◽  
Eric B Rimm ◽  
Alice H Lichtenstein ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Repeated Measures ◽  
High Sensitivity ◽  
Community Based ◽  
Reactive Protein ◽  
Inflammatory Status ◽  
Increased Risk ◽  
Hs Crp ◽  
Wbc Count

Abstract BACKGROUND Most previous studies regarding chronic inflammation and risk of myocardial infarction (MI) have lacked repeated measures of high-sensitivity C-reactive protein (hs-CRP) and/or white blood cell (WBC) count over time. We examined whether cumulative average and longitudinal changes in these biomarkers were associated with subsequent MI risk. METHODS In this prospective, community-based study, we included 82544 Chinese participants [66796 men and 15748 women; mean (SD) age 55.1 (9.86) y] without prior cardiovascular diseases or cancer at baseline (2006–2007). hs-CRP, WBC and other clinical covariates were assessed at baseline and every 2 years during follow-up. RESULTS During 6 years of follow-up (2006–2012), we documented 714 incident MI cases. Higher baseline and cumulative average concentrations of hs-CRP and/or WBC were consistently associated with increased risk of MI (Ptrend &lt;0.001 for both). Longitudinal increase in hs-CRP (Ptrend &lt;0.001), but not WBC, was also associated with a higher future risk of MI, after adjustment for their baseline values and other covariates. Each 1-mg/L increment per year in hs-CRP was associated with a 9.3% increase in risk for future MI [hazard ratio (HR) = 1.09, 95% CI, 1.03; 1.17]. Participants with high-grade inflammatory status (hs-CRP ≥10 mg/L and WBC ≥10 × 109/L) had a higher risk of MI occurring &lt;3 months after hs-CRP/WBC assessments vs those with hs-CRP &lt;0.5 mg/L and WBC &lt;5 × 109/L (HR = 6.64; 95% CI, 1.49–29.6), as compared with MI occurring ≥4 years (HR = 2.95; 95% CI, 0.90, 9.65). CONCLUSIONS Plasma hs-CRP concentration and WBC predicted MI risk. Longitudinal increase in hs-CRP was also associated with a higher risk of MI.

scholarly journals Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology (LETSGO study): a study protocol for a multicentre longitudinal interventional study using mobile health technology and biobanking

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e050930
Author(s):  
Ingvild Vistad ◽  
Mette Skorstad ◽  
Ingrid Demmelmaier ◽  
Milada Cvancarova Småstuen ◽  
Kristina Lindemann ◽  
...  
Keyword(s):  
Physical Activity ◽  
Patient Education ◽  
Repeated Measures ◽  
Psychosocial Support ◽  
Action Planning ◽  
Smartphone Application ◽  
Randomised Study ◽  
Time To Recurrence ◽  
Health Related

IntroductionThe number of gynaecological cancer survivors is increasing and there is a need for a more sustainable model of follow-up care. Today’s follow-up model is time-consuming and patients have reported unmet needs regarding information about their cancer and strategies for managing the consequences of treatment. The main aim of this study is to assess health-related empowerment—in terms of patient education, psychosocial support, and promotion of physical activity—in a new follow-up model by comparing it to standard follow-up in a quasi-randomised study involving intervention hospitals and control hospitals.Methods and analysisAt the intervention hospitals, patients will be stratified by risk of recurrence and late effects to either 1 or 3 years’ follow-up. Nurses will replace doctors in half of the follow-up visits and focus in particular on patient education, self-management and physical activity. They will provide patients with information and guide them in goal setting and action planning. These measures will be reinforced by a smartphone application for monitoring symptoms and promoting physical activity. At the control hospitals, patients will be included in the standard follow-up programme. All patients will be asked to complete questionnaires at baseline and after 3, 6, 12, 24 and 36 months. Blood samples will be collected for biobanking at 3, 12 and 36 months. The primary outcome is health-related empowerment. Secondary outcomes include health-related quality of life, adherence to physical activity recommendations, time to recurrence, healthcare costs and changes in biomarkers. Changes in these outcomes will be analysed using generalised linear mixed models for repeated measures. Type of hospital (intervention or control), time (measurement point), and possible confounders will be included as fixed factors.Ethics and disseminationThe study is approved by the Regional Committee for Medical Research Ethics (2019/11093). Dissemination of findings will occur at the local, national and international levels.Trial registration numberNCT04122235.

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